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The surgeon who treated a young Jakarta blast victim fears the five-year-old may have paralysis, reports Connie Levett from Singapore.

In the cramped confines of an intensive care unit, two fathers are taking turns to talk to a five-year-old child in English and Italian, to hold her hand as she fights for her life, a two-centimetre-square lump of shrapnel lodged in her brain.

Both men claim the girl, "Manny", Elisabeth Manuela Banbin Musu, as their own daughter.

"That shrapnel is like a bullet in the brain," said Ng Puay Yong, consultant neurosurgeon at Singapore's Mount Elizabeth Medical Centre, who conducted the four-hour life-saving operation on Friday night to remove a large blood clot from the left side of Manny's brain.

Each day Dr Ng meets the families in turn. "We try to brief them every day. We do it separately, we try to be tactful," said Dr Ng, who refused to say who was listed as the next of kin on hospital documents.

He plans to slowly bring Manny out of sedation today, but as she regains consciousness another battle is just beginning over who will take the little girl home when she is finally ready.

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"For the Australians she is Australian, but for the Italians she is Italian. We are not saying she is not Australian, but she has double citizenship," said Laura Siano, consular attache for the Italian embassy in Singapore. "She has lived in Italy for five years. She speaks Italian and only a few words of Bahasa and English."

Ms Siano accompanied Enrico Musu, Manny's Italian grandfather, as he showed the child's two Italian passports, one as a baby and her current one. The Italian father, Manuel Musu, left Singapore for Jakarta on Saturday for the funeral of his wife and was expected to return late last night.

The Australian father, David Norman, hiding his face from the waiting media, came to the hospital mid-morning yesterday. He issued a statement through the Australian high commission that he wanted to focus only on his daughter's wellbeing.

DNA tests carried out in Singapore five months ago had confirmed Mr Norman as the father, according to The Straits Times. However, Enrico Musu disputed the results of that test.

"Manny is really my son's daughter. David has never spent a single cent on Manny, has never done anything for her," he said.

What was apparent as Dr Ng detailed Manny's injuries yesterday was that her recovery would be long and arduous. He expects she will suffer some paralysis on her right side.

As well as the shrapnel lodged in the membrane that separates the two halves of her brain, she has a lung wound that will make her prone to infection, which could then affect blood flow to the brain. A stomach injury is stable but a severe infection could result if there is leakage into the abdomen. There is also a deep back wound.

Elisabeth Manuela Banbin Musu

Dr Ng said the treatment, first in Jakarta then in Singapore, had "brought her back from the brink", but she would likely require lifelong treatment for her injuries. The worst-case scenario is complete paralysis of the right side of her body.

"I wouldn't say the worst is over because there are a lot of potential complications from the brain, the back, the abdomen. Each individual one is bad enough, and if you add everything together you can imagine," he said.

However, before the operation, there had been no pupil response, but now both were reacting. "She is obviously still with us," Dr Ng said.